Hlela Funeral Magazine subscription form

Hlela Funeral Magazine subscription form
Hlela Medial (Pty) Ltd, PO Box 505, Northriding, 505 / Tel (011) 431 0566 / Email: marketing@hlelamedia.co.za
Please enrol me as a subscriber to Hlela Funeral Magazine. My application is for 4 upcoming issues
(1 per quarter) which should be posted to the address provided below.
Name and Surname:……………………………………………………………………………………………………………………………………………
Postal Address: …………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………………………
Tel:...........................................................email:.....................................................................................................
OPTION 1
Please debit my bank account (details provided below) with the once of subscription fee of R50.00.
Name of account holder:……………………………………………………………………………………………………………………………………
Name of Bank……………………………………………………………………Branch……………………………..……………………………………
Account number………………………………………………………………………………………………………………………………………………..
Today’s date…………………………………………………………………….Signature………………………………………………………………..
OPTION 2
I will do a direct deposit into Hlela Media’s bank account and email the proof of payment to
marketing@hlelamedia.co.za.